Abstract
BackgroundThe incidence and magnitude of indicators of radiographic response of pancreatic cancer to systemic chemotherapy and (chemo)radiation administered prior to anticipated pancreatectomy are unclear.MethodsSequential computed tomography scans of 226 patients with localized pancreatic cancer who received chemotherapy consisting of 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) or gemcitabine and nanoparticle albumin-bound paclitaxel (GA) with or without (chemo)radiation and who subsequently underwent surgery with curative intent from January 2010 to December 2018 at The University of Texas MD Anderson Cancer Center and Verona University Hospital were re-reviewed and compared.ResultsOverall, 141 patients (62%) received FOLFIRINOX, 70 (31%) received GA, and 15 (7%) received both; 164 patients (73%) received preoperative (chemo)radiation following chemotherapy and prior to surgery; and 151 (67%), 70 (31%), and 5 (2%) patients had Response Evaluation Criteria in Solid Tumors (RECIST) stable disease, partial response, and progressive disease, respectively. The tumors of 29% of patients with borderline resectable or locally advanced cancer were downstaged after preoperative therapy. Radiographic downstaging was more common with chemotherapy than with (chemo)radiation (24% vs. 6%; p = 0.04), and the median tumor volume loss after chemotherapy was significantly greater than that after (chemo)radiation (28% vs. 17%; p < 0.01).ConclusionsLess than one-third of patients treated with FOLFIRINOX or GA with or without (chemo)radiation experienced either RECIST partial response or radiographic downstaging prior to surgery. The incidence of tumor downstaging was higher and the magnitude of tumor volume loss was greater following chemotherapy than after (chemo)radiation.
Highlights
The incidence and magnitude of indicators of radiographic response of pancreatic cancer to systemic chemotherapy andradiation administered prior to anticipated pancreatectomy are unclear
More than 30% of all patients who present with pancreatic ductal adenocarcinoma (PDAC) do so with infiltrative, borderline resectable (BR), or locally advanced (LA) tumors without distant metastases
Whereas the role of surgery following chemotherapy and/orradiation is limited in patients who present with LA cancers, such patients may be considered for resection in the event of significant tumor downstaging
Summary
The incidence and magnitude of indicators of radiographic response of pancreatic cancer to systemic chemotherapy and (chemo)radiation administered prior to anticipated pancreatectomy are unclear. Margin-negative (R0) pancreatectomy, the treatment modality most likely to lead to long-term local control and survival in patients with PDAC, is unlikely for most of such patients.[1] Partly in an attempt to reduce the size or anatomic extent of primary tumors, and thereby improve the ability of surgeons to achieve R0 resection, patients with large and/or invasive pancreatic tumors have increasingly undergone sequential chemotherapy and/or (chemo)radiation prior to pancreatectomy. This represents the current standard of care for the treatment of BR PDAC.[2,3] Whereas the role of surgery following chemotherapy and/or (chemo)radiation is limited in patients who present with LA cancers, such patients may be considered for resection in the event of significant tumor downstaging
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